Periodontal Case StudyLeslie Bebber Fall 2009

PATIEN T: Age: Gender: Height: Weight: Vital Signs:

Jenny Gingivitis 22 Female 5ft 10in 175 HR: 64 Respiratory rate: 14 Blood Pressure: 124/86 Temperature: 98.6

CURRENT MEDICATIONS CURRENT MEDICATIONS

SUMMARY OF MEDICAL HISTORY SUMMARY OF MEDICAL HISTORY

Chief complaintBad breath and gums bleed when she brushes

SOCIAL HISTORY AND STORY SOCIAL HISTORY AND STORY

DENTAL HISTORY DENTAL HISTORY

ADDITIONAL INFORMATION ADDITIONAL INFORMATION

PSYCHOSOCIAL ASSESSMENT PSYCHOSOCIAL ASSESSMENT

Psychosocial ContCoping Strategies:Patient states that she usually deals with stress by exercising but has not found the time to do so in the past 6 months Appears to have a weak self-efficacy Support: Patient states that she has a large family and many friends that she relies on for support, however with the move she has not had them there for support. Obstacles: Work, school, distance from family

Radiographs

INTRAORAL PICTURES

DENTAL CHARTING

EXTRA/INTRA ORAL EXAM

Extra/Intra Oral Exam Cont.

Initial Gingival Description

Marginal: red, edematous, rounded rolled (generalized)Papillae: red, bulbous (generalized)Attached: firmly bound down Consistency: soft, smooth and shiny Attachment is at the CEJ Generalized BOP Note:Changes due to capillary proliferation, T & B lymphocytes occuring in equal numbers, collagen destruction, junctional epithelium thickens, rete pegs extend into connective tissue

PLAQUE CONTROL RECORD

96% upon 1stvisit 68% upon 2nd visit 3 months later

Goal is 15% next visit Patient is practicing better home care, however stressful conditions still exist. Improvement needed in the interproximal areas of all quads.

PERIODONTAL CHARTING

Periodontal Charting Mandibular

Summary of Perio Charting

Patient exhibited generalized bleeding No attachment loss Pockets of 4 and 5mm due to tissue inflammation Positive FGM readings due to tissue inflammation

CURRENT ORAL HYGIENE

Summary of Patient's Current Oral Hygiene Regimen

Brushes once a day (am) Scope at night Often uses Scope in replace of brushing No interproximal device used Soft, manual brush Aquafresh toothpaste (whatever is on sale)

DIAGNOSIS DIAGNOSIS

TREATMENT PLAN TREATMENT PLAN

PROGNOSIS PROGNOSIS

DATE

TREATMENT RECORDComprehensive exam Prophy Polish, floss and fluoride

7/15/09

Comprehensive exam Prophy 10/17/09 Polish, floss and fluoride Patient's next appointment is scheduled for this date

3/18/09

Other Treatment Information

Patient was treatment planned for fluoride due to the high potential of caries with her current status (she currently does not exhibit any signs of caries) A 3 month recall was done to ensure patient was on the right track and that the condition had improved At the 3 month recall there was great improvement in plaque control but more improvement is needed. It was determined that the patient could be put on a 4 to 5 month recall BOP was greatly reduced Plaque score went from 98 to 68

OHI Instructions

Sonic Care Toothbrush Waxed flossRecommended interproximal brushes and floss pics that patient could use on the go due to her busy schedule

Listerine 2x daily, 30sec prior to brushing Brush with PreviDent 5000+, spit well, do not rinse, prior to bed time (patient does not exhibit caries atthis time, however this is a new condition due to patient's current condition...thus the use of PreviDent for a prevenative measure)

Post Treatment Results

BOP reduced to less than 30% Plaque score reduced 30% (reinforced properhome care)

Probe depths reduced to 3mm with only three sites of 4mm Marginal gingiva was still red in the lower anteriors but little to no edematous tissue, stippling and resilience has returnedGoal: Plaque score of 15 to 20% at next visit

QuestionsPocket formation associated with plaque-induced gingivitis may be attributed to all of the following EXCEPT: (p.107) a. edema b. hypertrophy

c. migration of the PDLd. deepened penetration of the periodontal probe

True or FalseThe bacteria associated with plaque-induced gingivitis are predominantly gram-negative bacteria. (p.107)

Questions ContPlaque induced gingivitis may be modified by local and systemic factors. Alll of the following may be contributing factors EXCEPT: a. crowded teeth b. circulating corticosteroids c. changes in the endocrine system

d. NSAIDS True or FalseBacteroides species will increase in the subgingival plaque as the female hormones increase.

One Final QuestionTrue or False The most common form of gingivitis is plaque-induced.

ReferencesPerry, A Dorothy and Phyllis L. Beesterboer. Perio for Dental Hygienist. St Louis, Missouri, 2007.Southern, N Elizabeth, Gayle B McCombs, S Lynn Tolle and Ken Marinak. The Comparative Effects of 0.12% Chlorhexidine and Herbal Rinse on Dental Plaque-Induced Gingivitis. Journal of Dental Hygiene 80 (January 2006): 1-10. Trombelli L, Scapoli C, Tatakis DN, Grassi L. Modulation of Clinical Expression of Plaque-Induced Gingivitis: Effects of Personality Traits, Social Support and Stress. Journal of Clinical Periodontology 32 (2005): 1143-1150. Slattery, J. M. Psychosocial History. Conseling Diverse Clients. 2004.

http://psy1.clarion.edu/jms/intpsychosoc.htm